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Newly Diagnosed: Question to Ask Your Doctor About Glaucoma

Newly Diagnosed: Question to Ask Your Doctor About Glaucoma

If you have been newly diagnosed with glaucoma or you are a glaucoma
suspect, you may want to have a list of questions to ask
your doctor.

Be prepared to write down the answers you receive. In addition to
taking your own notes at the doctor's
office, keep a journal of anything you experience such as drug side
effects (what and when) so you won't have to rely on memory at your
next appointment.

A newly diagnosed person with glaucoma may benefit from frequent eye
pressure monitoring. Having your eye pressure checked
frequently and at different times of the day initially can help you and
your doctor find the ideal treatment
regimen.

Initially I supplemented visited to my ophthalmologist with visits to a
friendly optometrist who checked my eye pressure every week. That was
over a decade ago. Today my ophthalmologist, inspired by work done by
the FitEyes community, loans a handheld eye pressure monitor to his
patients. This is a wonderful advance in glaucoma care to allow for
very frequent eye pressure monitoring at home.

Unfortunately, home eye pressure monitoring is still relatively rare.
However, it doesn't hurt to ask your doctor
if he or she is familiar with home monitoring. You might just be
surprised and find that your doctor, like
mine, is willing to loan you a device to get you started.

Many FitEyes members have purchased their own professional instruments
to perform ongoing home monitoring. But if you are newly diagnosed, you
probably want to educate yourself before contemplating such a decision.
In this article we will stick to the topic of questions
you can ask your ophthalmologist.

Training

First, find out something about your doctor's
training. Ophthalmologists are medical doctors (M.D.s)
who specialize in eye care and have completed four years of college,
four years of medical school, an ophthalmology residency and possibly
additional training.

About the highest level of training for a glaucoma specialist is a
glaucoma fellowship. My own doctor is unique in that he
has completed two glaucoma fellowships (one was clinically oriented and
the other was research oriented) and in each case he studied under a
top expert. It would be useful to ask your doctor
where he or she completed their glaucoma fellowship.

Some ophthalmologists specialize in glaucoma without having completed a
glaucoma fellowship. If this is the case, you can ask
about their advanced training in glaucoma.

If you are seeing an ophthalmologist who is not a glaucoma specialist,
they can still treat you, but my experience is that, in most cases, you
will receive state of the art treatment. (There are exceptions, of
course. For example, in Southern California, I know an opththalmologist
who is not a fellowship trained glaucoma specialist, but is highly
recommended for glaucoma and does offer state of the art treatment. So
ask the questions about training, but don't be closed to a great doctor
who has an unconventional background.)

An optometrist (also called a Doctor of Optometry or O.D.
in the USA) is an eye doctor who has completed
pre-professional undergraduate education in a college or university
plus four years of professional education at a college of optometry.
Most optometrists focus on performing eye exams and vision tests and
prescribing eye glasses and contact lenses. None perform surgery (as
they are not M.D.s). However, some optometrists complete an optional
residency in a specific area of practice such as glaucoma. There are
optometrists who are highly knowledgeable about glaucoma. I have
personally received excellent care and advice from my optometrist. He
is a key member of my medical support team.

your It is important that your doctor
responds to you questions, listens to your
concerns and treats you with respect. Our position is that your
doctor should be willing to explain your
treatment options in a way that you understand. Many doctors
earn their largest income from surgical procedures, so consider whether
doctor fairly explains the treatment options that don't
benefit his or her bottom line.

If you do not feel confident and comfortable with your doctor,
remember, you always have the right to seek a second opinion. A good
working relationship with your eye doctor
facilitates effective treatment.

Don’t be afraid to ask questions!

Ask questions about the medications, results
and possible side effects. If side effects are intolerable, let your
doctor(s) know as soon as possible so they can work on
finding a more suitable medication.

Here are some specific questions you can ask
to help you gather all of the information you need.

The Basics

What type of glaucoma do I have? (Learn more about types of
glaucoma here.)

Treatment Options

If I wish to delay treatment for a few days while I educate
myself further, what are the risks in doing so?

What could happen without any treatment?

What medications do you recommend? Will they interact with any
other medications or dietary supplements I am taking?

How will I know if the treatment is working? Will you support
initial frequent eye pressure monitoring?

How often will I need checkups after my initial treatment plan is
settled?

Lifestyle

In our experience as glaucoma patients, lifestyle factors are extremely
important. These lifestyle factors could include exercise, stress management, meditation, diet, dietary supplements, and other things. Most
doctors
do not specialize in any of these areas. Most of us have had to learn
about how lifestyle factors and glaucoma go together. That's what FitEyes is for.

However, it doesn't hurt to ask your doctor
about exercises (both those that are recommended and those to avoid).
You can also ask about any other activities you should
avoid or any special precautions you should take.

In general, many glaucoma patients face few, if any, activity
restrictions -- with the possible exception of inverted yoga postures
or trumpet playing. However, even the inverted yoga posture restriction
is somewhat speculative. Therefore, it pays to keep educating yourself
so that you become your own expert on lifestyle and
glaucoma.

Other Risk Factors

nocturnal hypotension

sleep apnea

positional effects while sleeping

others - to be finished

As a general rule, the single most important medical treatment
you take advantage of to reduce your risk of further glaucoma
progression is to further reduce your IOP (even if you have NTG!).
And the best way to do that is to monitor your IOP at home so you
really learn how it behaves.

Advanced Considerations

All glaucomas have a final
common pathway
of retinal ganglion cell death involving low-grade inflammation,
oxidative damage, mitochondrial dysfunction,
and glial hyperactivation.

The fact that IOP is not in that list simply reflects the fact
that those are the more fundamental underlying factors. But IOP
remains the only medically treatable risk factor for all types
of glaucoma.

Here is a more complete list of the factors underlying glaucoma, as
I see them:

dysregulation of aqueous humor outflow (of which elevated IOP is
a symptom)

I continue to believe that the even deeper underlying factors are:

habitual emotional states

dominant thought habits

degree to which we consistently stay very well-rested (including
sleep)

dietary habits

exercise habits

habitual eye strain (e.g., do you blink frequently, do you see
stationary objects as moving, etc.)

habitual strain of any type in our lives

breathing habits (e.g., do we tend to breathe shallowly)

other lifestyle factors yet to be identified

and, of course, genetics. But DNA is not destiny. There is not a fixed one-to-one relationship between a gene's coding region and the protein that is produced. So don't conclude that there is nothing you can do if you have "glaucoma genes". Our lifestyle alters the expression of our DNA.

Your Support Team

Utilize your doctor's support team. The
trained staff at your doctor's office, such
as nurses and technicians, can be an enormous support to helping you
manage your disease. These knowledgeable professionals
can often give you the information, time, and attention that can make a
big difference.

You can have your own support team too. For example, you
may want to bring a friend or family member to your
appointment to help you capture all the information. This can be
especially helpful if your diagnosis is recent, since the
diagnosis may create a shock-like state that makes it hard to absorb
all the information the doctor provides.